Arterial pulsatile hemodynamic load induced by isometric exercise strongly predicts left ventricular mass in hypertension

作者：Chirinos Julio A^*; Segers Patrick; Raina Amresh; Saif Hassam; Swillens Abigail; Gupta Amit K; Townsend Raymond; Emmi Anthony G Jr; Kirkpatrick James N; Keane Martin G; Ferrari Victor A; Wiegers Susan E; Sutton Martin G St John

来源：American Journal of Physiology - Heart and Circulatory Physiology, 2010, 298(2): H320-H330.

DOI：10.1152/ajpheart.00334.2009

• arterial load
• arterial compliance
• wave reflections
• aortic stiffness

Chirinos JA, Segers P, Raina A, Saif H, Swillens A, Gupta AK, Townsend R, Emmi AG, Jr., Kirkpatrick JN, Keane MG, Ferrari VA, Wiegers SE, Sutton MG. Arterial pulsatile hemodynamic load induced by isometric exercise strongly predicts left ventricular mass in hypertension. Am J Physiol Heart Circ Physiol 298: H320-H330, 2010. First published December 4, 2009; doi:10.1152/ajpheart.00334.2009.-Although resting hemodynamic load has been extensively investigated as a determinant of left ventricular (LV) hypertrophy, little is known about the relationship between provoked hemodynamic load and the risk of LV hypertrophy. We studied central pressure-flow relations among 40 hypertensive and 19 normotensive adults using carotid applanation tonometry and Doppler echocardiography at rest and during a 40% maximal voluntary forearm contraction (handgrip) maneuver. Carotid-femoral pulse wave velocity (CF-PWV) was measured at rest. Hypertensive subjects demonstrated various abnormalities in resting and induced pulsatile load. Isometric exercise significantly increased systemic vascular resistance, aortic characteristic impedance (Zc), induced earlier wave reflections, increased augmentation index, and decreased total arterial compliance (TAC; all P <= 0.01). In hypertensive subjects, CF-PWV was the strongest resting predictor of LV mass index (LVMI) and remained an independent predictor after adjustment for age, gender, systemic vascular resistance, reflection magnitude, aortic Zc, and TAC (beta = 2.52 m/s; P < 0.0001). Age, sex, CF-PWV, and resting hemodynamic indexes explained 48% of the interindividual variability in LVMI. In stepwise regression, TAC (beta = -17.85; P < 0.0001) during handgrip, Zc during handgrip (beta = -150; P < 0.0001), and the change in the timing of wave reflections during handgrip (beta = -0.63; P = 0.03) were independent predictors of LVMI. A model that included indexes of provoked hemodynamic load explained 68% of the interindividual variability in LVMI. Hemodynamic load provoked by isometric exercise strongly predicts LVMI in hypertension. The magnitude of this association is far greater than for resting hemodynamic load, suggesting that provoked testing captures important arterial properties that are not apparent at rest and is advantageous to assess dynamic arterial load in hypertension.

• 出版日期2010-2